In some doctors’ offices, the weigh-in is no longer required

Until she was in her mid-30s, Xanthia Walker rarely went to the doctor, even when she needed care. She didn’t want to step on the scale.

When she did go in — to treat sciatic nerve pain or get antibiotics — somehow the conversation always turned to her weight.

“Even when I went in about migraines, the response was, ‘Well, if you lost weight that would probably go away,’” she recalled.

That changed when Walker, 40, who lives in Phoenix, found a new physician. Dr. Natasha Bhuyan rejects what she calls the “weight-centric” model of medicine.

Instead, she favors a “weight-inclusive” approach recognizing that people come in different shapes and sizes, and that the number on the scale does not necessarily predict health status.

“When a person comes in, the first thing we do is not check their weight,” said Bhuyan, who is the vice president of in-office care and national medical director at One Medical, a primary care practice owned by Amazon.

“We bring them back, sit in the exam room, and just talk with them,” she said. “It’s a paradigm shift — if we do feel we need to check their weight, we get their permission.”

That approach is still controversial for many doctors. Medical school students are taught that a patient’s weight is one of the vital signs that should be checked at each medical encounter, like blood pressure.

And it runs headlong into the deeply ingrained belief that patients can control their weight if they put their minds to it.

Critics note that obesity is the top health concern in the United States, stoking Type 2 diabetes and hypertension, and contributing to heart disease, stroke and some cancers. They say physicians should address weight as the No. 1 priority.

Ignoring a patient’s weight is missing an opportunity, said Dr. Caroline M. Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.

“I can see doing this maybe 10 or 20 years ago, but now? Now that we have these great new treatments, why would you do this?” Apovian said, referring to powerful new weight-loss drugs and bariatric surgery.

If anything, she said, doctors should focus on the patient’s obesity before the medical conditions that often come with it.

“If primary care providers all over the country can address the obesity first and treat it, then in the long run we are going to reduce the incidence of all these other problems,” she said.

Body weight “is as much a vital sign as blood pressure and respiratory rate,” said Dr. Steven B. Heymsfield, a professor of metabolism and body composition at Louisiana State University’s Pennington Biomedical Research Center.

“Unless the patient is phobic around their weight for some reason, it makes no sense not to quantify it from the medical perspective,” he said.

While asking for a patient’s consent before weighing can foster “a more patient-centered approach,” said Dr. Fatima Cody Stanford, an obesity specialist at Harvard Medical School, “it is crucial that patients are informed about the options available to them, including weight management strategies, and that these discussions are approached with empathy and support.”

But doctors who eschew routine weigh-ins believe the link between excess weight and harmful chronic health conditions has been overemphasized in medical training.

Telling patients they are fat is almost guaranteed to drive them away from care while doing little to improve their health, they say.

And research shows that maintaining an optimal weight is not about willpower. A person’s weight is also the product of genetics, early childhood experiences and other environmental and social factors.

New medications like Ozempic are challenging the traditional mindset among medical professionals by demonstrating that biology can matter more than willpower.

“At an annual physical, that is a definitely a time when I do want to know the patient’s weight, but what I’m looking for is a big fluctuation in one direction or another,” said Dr. Alexa Mieses Malchuk, speaking for the American Academy of Family Physicians.

A major swing could indicate nutritional deficits, an endocrine disorder or a malignancy, she said. But routine weigh-ins at every appointment are “a bad practice,” and something that “some medical practices are moving away from, and I hope all will move away from.”

The U.S. Preventive Services Task Force first recommended screening patients for obesity in 2012, saying that those with a body mass index of 30 or above should be treated with “intensive, multicomponent behavioral interventions.”

The task force, which prides itself on developing evidence-based guidelines, acknowledged at the time that there was not much evidence proving the interventions would have an impact on long-term health. The screening has nevertheless become enshrined in medical practice.

There have always been physicians who adhere to the “health at any size” approach. But recently, several larger practices have eliminated routine weigh-ins at all encounters for adult patients who aren’t pregnant.